Answering a few questions will help you code correctly for laceration repairs (such as staples, sutures, or similar closure materials): Was the repair limited to the epidermis, dermis, and subcutaneous tissue, or did you need to probe more deeply?Use simple repair codes for superficial wounds (epidermis and dermis) that need only a single-layer closure. If […]
Critical care medicine specialists diagnose and treat a wide variety of diseases. A multidisciplinary team approach is needed to care for critically ill patients. Though there are only two codes for critical care services, reporting critical care presents a challenge because of the rules and regulations involved. In fact, Medicare and commercial payers scrutinize the […]
For any case of pregnancy in which a woman uses opioids during the pregnancy or postpartum period, codes from subcategory O99.32, Drug use complicating pregnancy, childbirth, and the puerperium, should be assigned. A secondary code from category F11, Opioid-related disorders, should also be assigned to identify the manifestation of Opioid Use and Counseling. Opioid Use […]
Billing and Coding Guidelines (continued…) Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. Providers should bill for devices at the beginning of the treatment course and then may bill again later in […]
Major Reasons for Denial Services performed for diagnoses not listed as covered in this policy or for excessive frequency will be denied as not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation. Indications not listed […]
The American Medical Association (AMA) announced the release of the 2021 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic service available to patients. Trusted since 1966 as the health system’s common language, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services […]
CPT Code 99214 is commonly used for billing office or outpatient visits involving established patients with moderate to high complexity in medical decision-making. To meet the criteria for this level of Evaluation and Management (E/M) service, proper documentation is critical. It requires a detailed history, detailed examination, and medical decision-making of moderate to high complexity. […]
Reimbursement analysis provides an accurate picture of the reimbursement environment, which is important to ensure your practice will be able to provide new, innovative services. A comprehensive reimbursement analysis should be conducted with adequate lead time to include an in-depth understanding of payer-mix, the delivery cost of the new service, and the anticipated reimbursement by […]
According to some sources, patients are now the third-largest payer group in the US behind Medicare and Medicaid. So, now is not the time to let those amounts due slide! One of the best ways to capture those amounts due is by avoiding surprises on the part of the patient by letting them know right […]
The stakes are high. Coding drives revenue. Coding compliantly is demanded of all practices. Physician compensation is often determined by the RVUs associated with the CPT code that is submitted on the claim form. Health systems and hospitals want to ensure that services submitted under the group NPI are accurate and represent what was done […]
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